ABSTRACT
Objective:To summarize the clinical experience and effect of applying 3D printing assisted with the technology of extracorporeal pre-fenestration in the treatment of thoracic/abdominal aortic aneurysm.Methods:From August 2019 to November 2020, 15 patients with thoracic/abdominal aneurysm involving visceral arteries were admitted to our center, including 11 males and 4 females, with mean age of 57-82(68.26 ±4.73) years old. According to diameters of visceral artery, thoracic aorta, abdominal aorta, and bilateral iliac arteries measured by CTA, we selected suitable stents and made a 3D printing model by professional software to guide the position of intraoperative external fenestration and the fenestration diameter to implement full cavity repair.Results:All operations were completed and one case was converted to laparotomy. The average time of operations was(200.67±41.00)min and hospital stay was(13.47±4.16)days without any death, organ failure, endoleak, paraplegia, graft infection and other complications.Conclusion:The application of 3D printing assisted with the technology of extracorporeal pre-fenestration in the treatment of thoracic/abdominal aortic aneurysm is feasible and effective, and the short-term results are satisfactory.
ABSTRACT
<p>Endovascular treatment for chronic aortic dissection in patients with Marfan syndrome is still controversial. A 60-year-old man developed an extended chronic type B dissection involving the aortic arch and thoraco-abdominal aorta with a large entry at the distal aortic arch and patent false lumen. He had undergone David procedure for type A aortic dissection at age 42, and aortic valve replacement for recurrent aortic valve insufficiency at 58, which was complicated with mediastinitis. He also suffered drug-induced interstitial pneumonitis. Considering his complicated surgical history and impaired pulmonary function, conventional graft replacement of thoraco-abdominal aorta was thought to be quite a high risk. Thus, we chose debranch TEVAR with a staged approach. First, debranching and Zone 0 TEVAR with the chimney technique were performed. Then, 4 months later, abdominal debranching and TEVAR was performed. The patient tolerated both procedures well and was discharged home. Two years after last procedure, he is in good condition and computed tomography shows that complete entry closure and false lumen had thrombosed. This strategy may be worthy to be considered even for a patient with Marfan syndrome, in case the patient's condition is unsuitable for conventional surgery.</p>